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Die Zeiten ändern sich, wie es so schön heißt. Hausärzte gibt es immer weniger, die Therapien werden immer aufwendiger und wenn man Hilfe ruft, kommt der Rettungssanitätsdienst und der Patient landet im Krankenhaus. Dort werden die Ressourcen ebenfalls immer knapper und es entstehen dadurch lange Wartezeiten. Oft sind auch die Wege, die die Patienten für eine fachärztliche Versorgung zurücklegen müssen immer weiter, da die lokalen Versorgungseinheiten reduziert werden.
Eine Patientengruppe, die es hier oft besonders trifft, sind Menschen mit chronischen Wunden (offene Füße, Raucherbein, diabetisches Fußsyndrom …..). Trotz der meist vorhandenen Versorgung vor Ort durch den Hausarzt und den mobilen Pflegedienst, entsteht immer wieder die Notwendigkeit eines kleinen chirurgischen Eingriffes, um die Wunden zu reinigen oder nekrotisches (zu Grunde gegangenes) Gewebe zu entfernen. Wir nennen diesen Vorgang Debridement.
Der Eingriff kann einfach im Zuge eines Verbandswechsels durchgeführt werden, muss aber durch einen chirurgisch versierten Arzt ausgeführt werden. Also was passiert? Trotz guter Versorgung zu Hause erfolgt der Transport in ein oft einige Kilometer entferntes Krankenhaus zur ambulanten chirurgischen Behandlung mit dementsprechendem Zeitaufwand. Nachdem schon der Hausarzt und die mobile Pflege bereits zu Hause vor Ort Patienten versorgen, warum nicht auch ein Facharzt, in diesem Fall sogar ein Chirurg? Geht das? Natürlich!! Sicher, keiner darf sich erwarten, dass der Chirurg ins Haus kommt und die Gallenblase entfernt oder etwa den Blinddarm. Dafür braucht man einen sterilen OP, aber ein erweiterter chirurgischer Verbandswechsel, wie er bei der Behandlung von chronischen Wunden nötig ist, kann durchaus zu Hause durchgeführt werden. Oft ist auch nur die Expertise des Chirurgen notwendig, eine Indikationsstellung zur OP gefragt, oder einfach eine simple Naht fachgerecht zu setzen. In Kombination mit der hausärztlichen Behandlung und der mobilen Wundversorgung durch die mobilen Pflegedienste steht hier auch der Wundchirurg im Team zur Versorgung von schwer oder nicht mobilen Patienten zur Verfügung.
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